1629334438 NPI number — MEDICAL GROUPS OF DOWNTOWN FRESNO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629334438 NPI number — MEDICAL GROUPS OF DOWNTOWN FRESNO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL GROUPS OF DOWNTOWN FRESNO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629334438
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2841 TULARE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93721-1320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-284-7790
Provider Business Mailing Address Fax Number:
559-323-1857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2841 TULARE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93721-1320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-284-7790
Provider Business Practice Location Address Fax Number:
559-323-1857
Provider Enumeration Date:
04/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MOY
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
FAY
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
916-806-9778

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  G53062 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3447764 . This is a "CORPORATION NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com